The scientific community is in urgent need of reliable biomarkers related to COVID-19
disease progression, in order to stratify high-risk patients. The rapid disease spread
necessitates the immediate categorization of patients into risk groups following
diagnosis, to ensure optimal resource allocation. Novel biomarkers are needed to identify
patients who will suffer rapid disease progression to severe complications and death. The
identification of novel biomarkers is strictly related to the understanding of viral
pathogenetic mechanisms, as well as cellular and organ damage. Effective biomarkers would
be helpful for screening, clinical management, and prevention of serious complications.

Indeed, previous studies suggested and developed predictive scores (CALL, Chosen, HA2T2,
ANDC, ABC2-SPH, ICOP, SEIMC, IRS, NLP, APACHE II, GRAM, and others) that estimate the
severity of the disease, the risk of needing invasive mechanical ventilation (IMV) among
patients with COVID-19 and the risk of mortality. Many scores including so many relevant
parameters have been used to predict the status of a patient. In addition to
comorbidities, age, etc., some hematological parameters, including white blood cell
(WBC), lymphopenia, c-Reactive Protein (CRP), and some biochemical parameters, such as
lactate dehydrogenase (LDH), creatine kinase (CK), and troponin were reported to be
associated with COVID-19 severity. In fact, the patient's initial laboratory scoring is
useful but not sufficient to avoid mortality: high neutrophil count (>0.7 × 103/μL),
lymphopenia (<0.8 × 103/μL), elevated CRP (>4.75 mg/dL), and elevated LDH (>593 U/L) were
the most important predictors of mortality. Another prognostic marker the
lymphocyte-to-CRP ratio (LCR), was also helpful. A rise in the NLR and a decline in LCR
correlates with the severity of COVID-19. Specifically, a low LCR at presentation was
seen to predict ICU admission and the need for invasive ventilation. Patients critically
ill with COVID-19 had a hyperinflammation, the associated biomarkers may be beneficial
for risk stratification. Many studies found other associations with serum CRP,
procalcitonin (PCT), D-dimer, and serum ferritin. Subsequent studies demonstrate that the
inflammatory response plays a critical role in COVID-19, and inflammatory cytokine storm
increases the severity of COVID-19. In fact, the serum levels of IL-6 can effectively
assess disease severity and predict outcomes in patients with COVID-19. So, these
prognostic models have been introduced to guide treatment and resource management.

In this study, we aimed to specify high-risk factors and biomarkers of fatal outcomes in
hospitalized subjects with coronavirus depending on many variables analysis, and also to
compare the efficacy of targeted treatments (antiviral, antiretroviral, immunosuppressive
antagonist, etc.) in order to help clinicians better choose a therapeutic strategy.

The population had been divided into groups according to the WHO Ordinal Clinical
Severity Scale on which the LUSZ SCORE was applied; The percentage of mortality, in and
out of the hospital, the length of stay in the hospital, the pulmonary inflammatory
lesions and their distribution, the SARS-CoV-2 IgM and IgG variations at admission, the
inflammatory markers, the complete blood count, the coagulation factors and enzymes,
proteins and electrolytes profile, glucose and lipid profile, and others were measured
before and after LUSZ scoring. The establishment of this novel predictive scoring model
of disease progression may help identify patients with COVID-19 who may subsequently
develop a critical illness. Thus, we can improve the therapeutic effect and reduce the
mortality of COVID-19 with more accurate and efficient use of medical resources, which
helps to deliver proper treatment according to each case.